Abstract
Objectives: The study aimed to explore the clinical predictors of pharmaco-resistance in patients with post-stroke epilepsy (PSE). Methods: Patients with epilepsy secondary to cerebral infarct or spontaneous intracerebral hemorrhage were included. The study outcome was the occurrence of pharmaco-resistance defined as the failure of adequate trials of two tolerated and appropriately chosen and used antiseizure medication schedules, whether as monotherapies or in combination, to achieve sustained seizure freedom. Results: One-hundred and fifty-nine patients with PSE and a median follow-up of 5 (3–9) years were included. The mean age of the patients at stroke onset was 56.7 (14.9) years, and 104 (65.4%) were males. In the study cohort, 29 participants were pharmaco-resistant. Age at stroke onset [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.93–0.99; p = 0.044], history of intracerebral hemorrhage (OR 2.95, 95% CI 1.06–8.24; p = 0.039), severe stroke (OR 5.43, 95% CI 1.82–16.16; p = 0.002), status epilepticus as initial presentation of PSE (OR 7.90, 1.66–37.55; p = 0.009), and focal to bilateral tonic-clonic seizures (OR 3.19, 95% CI 1.16–8.79; p = 0.025) were independent predictors of treatment refractoriness. Conclusions: Pharmaco-resistance developed in approximately 20% of patients with PSE and was associated with younger age at stroke onset, stroke type and severity, status epilepticus occurrence, and seizure types.
Highlights
According to the International League Against Epilepsy definition, seizures occurring within 7 days of the onset of stroke were classified as acute symptomatic seizures, seizures occurring beyond 7 days of the onset of stroke were classified as unprovoked seizures, and Post-stroke epilepsy (PSE) was diagnosed as the occurrence of one or more unprovoked seizures [8]
Patients refractory to treatment presented more frequently intracerebral hemorrhage (p = 0.016) and severe stroke (p = 0.001) in comparison to responsive patients
Pharmaco-resistance developed in approximately 20% of the patients with PSE included in this study and was associated with younger age at stroke onset, intra-cerebral hemorrhage, severe stroke, occurrence of status epilepticus as the first late-onset epileptic symptom, and focal to bilateral tonic-clonic seizures
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Stroke is a leading disease worldwide, with an estimated incidence of 15 million cases annually [1]. Advances in stroke treatment have significantly reduced the overall mortality rate, whereas the number of survivors with complications and disability has increased [2,3,4]. Post-stroke epilepsy (PSE) is an important sequela of stroke, and represents one of the most common causes of acquired epilepsy. Cerebrovascular disease accounts for about 15% of all newly diagnosed epilepsy cases and nearly 50% among patients above
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